Individual
DR. GARY A JAGODZINSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
422 S MAIN ST, LIVINGSTON, MT 59047-3456
(406) 222-0636
(406) 222-0636
Mailing address
422 S MAIN ST, LIVINGSTON, MT 59047-3456
(406) 222-0636
(406) 222-0636
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1349
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0133965
—
MT
01
—
13494
BLUE CROSS BLUE SHIELD
MT
01
—
5511519
CHIP
MT
Enumeration date
01/23/2007
Last updated
07/08/2007
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